TY - JOUR
T1 - Novel Colorimetric and Light Scatter Methods to Identify and Manage Peritoneal Dialysis-Associated Peritonitis at the Point-of-Care
AU - Kennedy, Stephnie M.
AU - Kell, Darren
AU - Henderson, Duncan
AU - Garcia, Ana Yepes
AU - Milner, Adam S.
AU - Willett, Tom
AU - Griffiths, Ryan
AU - Foster, Peter
AU - Kilgallon, William
AU - Cant, Rachel
AU - Knight, Christopher G.
AU - Corbett, Richard
AU - Akbani, Habib
AU - Woodrow, Graham
AU - Sood, Bhrigu
AU - Iyasere, Osasuyi
AU - Davies, Simon
AU - Qazi, Junaid
AU - Vardhan, Anand
AU - Gillis, Laura
AU - Wilkie, Martin
AU - Dobson, Curtis B.
N1 - Publisher Copyright:
© 2024 International Society of Nephrology
PY - 2024/3/1
Y1 - 2024/3/1
N2 - Introduction: Peritoneal dialysis (PD)-related peritonitis (PDRP) is a common cause of transfer to hemodialysis, patient morbidity, and is a risk factor for mortality. Associated patient anxiety can deter selection of PD for renal replacement therapy. Diagnosis relies on hospital laboratory tests; however, this might be achieved earlier if such information was available at the point-of-care (POC), thereby significantly improving outcomes. The presence of culturable microbes and the concentration of leukocytes in effluent both aid peritonitis diagnosis, as specified in the International Society for Peritoneal Dialysis (ISPD) diagnostic guidelines. Here, we report the development of 2 new methods providing such information in simple POC tests. Methods: One approach uses a tetrazolium-based chemical reporting system, primarily focused on detecting bacterial contamination and associated vancomycin-sensitivity. The second approach uses a novel forward light-scatter device (QuickCheck) to provide an instant quantitative cell count directly from PD patient effluent. Results: The tetrazolium approach detected and correctly distinguished laboratory isolates, taking 10 hours to provide non-quantitative results. We compared the technical performance of the light scatter leukocyte counting approach with spectrophotometry, hemocytometer counting and flow cytometry (Sysmex) using patient effluent samples. QuickCheck had high accuracy (94%) and was the most precise (coefficient of variation <4%), showing minimal bias, overall performing similarly to flow cytometry. Conclusion: These complementary new approaches provide a simple means to obtain information to assist diagnosis at the POC. The first provides antibiotic sensitivity following 10 hours incubation, whereas the second optical approach (QuickCheck), provides instant accurate total leukocyte count.
AB - Introduction: Peritoneal dialysis (PD)-related peritonitis (PDRP) is a common cause of transfer to hemodialysis, patient morbidity, and is a risk factor for mortality. Associated patient anxiety can deter selection of PD for renal replacement therapy. Diagnosis relies on hospital laboratory tests; however, this might be achieved earlier if such information was available at the point-of-care (POC), thereby significantly improving outcomes. The presence of culturable microbes and the concentration of leukocytes in effluent both aid peritonitis diagnosis, as specified in the International Society for Peritoneal Dialysis (ISPD) diagnostic guidelines. Here, we report the development of 2 new methods providing such information in simple POC tests. Methods: One approach uses a tetrazolium-based chemical reporting system, primarily focused on detecting bacterial contamination and associated vancomycin-sensitivity. The second approach uses a novel forward light-scatter device (QuickCheck) to provide an instant quantitative cell count directly from PD patient effluent. Results: The tetrazolium approach detected and correctly distinguished laboratory isolates, taking 10 hours to provide non-quantitative results. We compared the technical performance of the light scatter leukocyte counting approach with spectrophotometry, hemocytometer counting and flow cytometry (Sysmex) using patient effluent samples. QuickCheck had high accuracy (94%) and was the most precise (coefficient of variation <4%), showing minimal bias, overall performing similarly to flow cytometry. Conclusion: These complementary new approaches provide a simple means to obtain information to assist diagnosis at the POC. The first provides antibiotic sensitivity following 10 hours incubation, whereas the second optical approach (QuickCheck), provides instant accurate total leukocyte count.
KW - diagnosis
KW - leukocyte
KW - peritoneal dialysis
KW - peritonitis
UR - http://www.scopus.com/inward/record.url?scp=85184201804&partnerID=8YFLogxK
UR - https://www.mendeley.com/catalogue/25c3055b-2b4c-3c77-83cc-88bc06f809f0/
U2 - 10.1016/j.ekir.2023.12.021
DO - 10.1016/j.ekir.2023.12.021
M3 - Article
C2 - 38481507
AN - SCOPUS:85184201804
SN - 2468-0249
VL - 9
SP - 589
EP - 600
JO - Kidney International Reports
JF - Kidney International Reports
IS - 3
ER -